Swollen joints a better indicator of synovitis than tender joints in psoriatic arthritis
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In patients with early psoriatic arthritis who are naïve to disease-modifying antirheumatic drugs, swollen joints are a better predictor of synovitis than tender joints, according to data published in Rheumatology Advances in Practice.
“Understanding the relationship between clinical joint tenderness/swelling and [ultrasound (US)] synovitis remains crucial for improving early identification of disease, decision-making and therapeutic intervention,” Sayam R. Dubash, FRCP, MBChB, of the University of Leeds, in the United Kingdom, and colleagues wrote.
To examine the relationship between tender and swollen joints and synovitis in early PsA, Dubash and colleagues conducted a single-center, cross-sectional, observational inception cohort study involving 155 DMARD-naïve patients with PsA who visited the Leeds Early Arthritis Clinic. The study included patients who visited the hospital between December 2013 and October 2019. Participating patients were enrolled in the Leeds Spondyloarthropathy Register for Research and Observation. Patients were considered for inclusion if they were older than 18 years, demonstrated three or more out of five PsA classification criteria and had no previous exposure to DMARDs.
Upon enrollment, patients had 44 joints examined via ultrasound with experienced sonographers conducting the scans. Gray scale scores of zero to one were considered normal, where ultrasound synovitis was defined as gray scale scores of two or greater and a power Doppler of one or greater.
In all, 155 patients had 5,616 joints examined through clinical and ultrasound examination. Among the examined joints, 1,039 (18.5%) were tender and 550 (9.8%) were swollen. Additionally, 1,114 (20.4%) participants demonstrated gray scale scores of two or greater while 292 (5.2%) had power Doppler scores of one or greater, according to the researchers. Gray scale scores of 2 or greater were independently associated with swelling (OR = 4.37; 95% CI, 2.62-7.29).
“Swollen joints were the better proxy for US synovitis (GS 2 and/or PD 1) compared with tender joints in DMARD-naïve early PsA,” Dubash and colleagues wrote. “These findings add to the understanding of how clinical examination relates to underlying pathologies on US imaging, which might help to improve the management of early PsA.
“Finally, these findings support the use of US for early PsA diagnosis, especially in the presence of tender non-swollen joints,” they added. “Further research on tender joints might improve the understanding of pathologies in early PsA.”
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